Posters

Bilateral arteritic anterior ischemic optic neuropathy as first sign of giant cell arteritis in a patient with primary open-angle glaucoma

Poster Details

First Author: C.Keskini GREECE

Co Author(s): P. Kalouda G. Karagiannidis-Stampoulis E. Kanonidou

Abstract Details

Purpose:

This is a case report aiming to present the rapid and manifest visual field deterioration of a primary open angle glaucoma patient with a new-onset bilateral arteritic anterior ischemic optic neuropathy (AAION) as first sign of giant cell arteritis (GCA).

Setting:

Department of Ophthalmology, ''Hippokrateion'' General Hospital of Thessaloniki, Thessaloniki, Greece.

Methods:

A 79-year old woman visited the ophthalmology emergency room due to sudden, painless visual loss of the left eye that was installed 2 days ago. The clinical examination findings were:
�â��¢ Visual Acuity (VA): Right Eye (OD) �â�� 0.1 LogMAR cc (ni)/ Left Eye (OS) �â�� Hand Motion sc (ni)
�â��¢ Fundoscopy: OD �â�� normal findings/ OS �â�� Optic disc edema with chalk white appearance
�â��¢ RAPD () OS
From the laboratory tests: ESR= 75mm/h
The patient did not mention any other symptoms such as new onset headache or pain in the jaw associated with chewing.

Results:

The patient was hospitalized with a high starting dose of intravenous methylprednisolone (1g for 3 days). Left temporal artery biopsy was obtained and had a positive result. During the second day of hospitalization OD VA was reduced to 0.7 LogMAR and OD optic disc edema was found during fundoscopy. Visual Field (VF) tests were performed with: OD: Blind spot enlargement (MD=22.4)
/OS: Complete visual field loss (MD=25.9)
The patient�â��s former VF (performed one year before the AAION onset) had OD glaucomatous defects (nasal step, MD=3.4) while OS had a normal VF with an MD= 4.1.

Conclusions:

The AAION as the first sign of giant cell arteritis in a patient with Primary Open Angle Glaucoma has led to a rapid and manifest deterioration of the patient�â��s visual field tests. In patients presenting in the emergency room with an anterior ischemic optic neuropathy GCA should always be a part of the differential diagnosis due to increased and immediate risk of bilateral involvement.